Splenic Switch-Off in 3D Adenosine Stress CMR Perfusion for Differentiating False-Negative from True-Negative Studies Identified by FFR

Károlyi, Mihály and Fuetterer, Maximilian and Kolossváry, Márton and Wilzeck, Verena C. and Plein, Sven and Biondo, Andrea and Gotschy, Alexander and Frick, Michael and Gebker, Rolf and Alkadhi, Hatem and Paetsch, Ingo and Jahnke, Cosima and Kozerke, Sebastian and Manka, Robert (2025) Splenic Switch-Off in 3D Adenosine Stress CMR Perfusion for Differentiating False-Negative from True-Negative Studies Identified by FFR. Journal of Cardiovascular Magnetic Resonance. No.-101933. ISSN 10976647 (In Press)

Preview

Text 1-s2.0-S109766472500095X-main.pdf - Published Version Download (1MB) | Preview

Abstract

Background: False-negative cardiac magnetic resonance (CMR) perfusion results may arise from inadequate stress responses, even when patients exhibit an adequate clinical or heart-rate response to adenosine. This study aimed to explore the ability of qualitative and quantitative splenic switch-off markers to differentiate false-negative from true-negative adenosine stress-perfusion CMR findings, in a cohort where fractional flow reserve (FFR) was used to adjudicate lesion significance. Methods: Patients with known or suspected coronary artery disease (CAD) from five centers underwent 3D adenosine stress perfusion CMR and coronary angiography with FFR. Splenic switchoff was assessed qualitatively using both standard stress-to-rest (SSO) and a stress-only (SSOstress) approach. In addition, quantitative signal intensity (SI) ratios were assessed, including the splenic stress-to-rest SI-ratio (SIstress/rest) and the spleen-to-myocardium SI ratio at stress (SIspleen/myocarcium). The diagnostic accuracy of these measures was evaluated using cross-validated area under the curve (cvAUC) analysis. Results: Among 179 patients (mean age 63 ± 10 years; 130 male), SSO prevalence was 73% and was significantly more frequent in true-negative than false-negative CMR cases (80.6% vs. 36.8%, p<0.001). SSOstress showed moderate agreement (κ = 0.60) and robust diagnostic performance (AUC 0.80), as compared to SSO. Splenic SIstress/rest and SIspleen/myocarcium at stress demonstrated high predictive accuracy for visual SSO, with cvAUCs of 0.94 (95% CI: 0.90–0.96) and 0.90 (95% CI: 0.860.95), respectively. The positive likelihood ratio of SSO for true-negative CMR was 1.70, while the negative likelihood ratio was 0.24, indicating false-negative CMR when SSO was absent. Qualitative and quantitative splenic-switch off metrics classified 77–80% of negative CMR cases correctly as true- or false-negatives, with sensitivities ranging from 81.4% to 91.2%. Clinically applicable cut-offs for differentiating true- and false-negative studies with splenic SIstress/rest and SIspleen/myocarcium at stress were identified as ≤0.32 and ≤0.38, respectively. Conclusion: In a multicenter cohort using FFR-adjudicated reference for lesion severity, qualitative SSO and quantitative signal intensity metrics were associated with myocardial stress adequacy and these markers may improve the interpretation of negative stress-perfusion CMR studies.

Actions (login required)

Edit Item